Donor Hearts Go to Waste

Donor heart utilization has fallen over the last two decades leaving many of the organs to go to waste. Only about one in three hearts that are donated will be accepted for patient transplant in the United States. However, the list of people in need of hearts keeps growing.

Benjamin Goldstein, PhD, functioned as the senior author on a study which was recently published in the American Journal of Transplantation. Kiran Khush, MD and other authors who also worked on the study reported that heart utilization was at a low of 26 percent in 2006. In 2010 the rates were only 36 percent. The low numbers, down from 44 percent in the year 1995,might be due to higher standards at some transplant centers. They also may be due in part to newer technology which can support patients for longer. Therefore, patients might choose to rely on mechanical circulatory devices instead of accepting a marginal heart.

A marginal heart can be defined by numerous characteristics including a heart that is small, or one that comes from an older patient. A heart might also be rejected for co-morbidities in the donor. For example, diabetes and hypertension. The rejection of these marginal donor hearts varies greatly across regions. Because the process for accepting hearts is not standardized, this causes many potentially useful donor hearts go to waste. Khush who is both a cardiologist and an Assistant Professor of Medicine at Stanford University, argues that standard guidelines should be implemented for marginal hearts.

One example in Khush’s recent study shows that during the year 2011 out of roughly 20,000 people who were in need of a heart only 1,949 received one in that year. Results of the study prove that it is particularly important that “a set of consistent, scientifically based guidelines” be implemented for transplant centers and surgeons so that they can have a standardized method for accepting or rejecting donor hearts.

John Nguyen was a co-author of the study and works with the California Transplant Donor Network. Nguyen argues that a great number of hearts are suitable for transplant, but they are not being used. Increasing the number of hearts that are used is of concern to medical professionals who work with transplants because the longer a patient has to wait, the sicker he or she usually becomes. Khush admits that they regularly lose patients.

The study conducted by Khush and others further explained that there is little evidences to prove that using a marginal heart decreases adverse consequences or increases the length of the patient’s life. Since these factors may be non-existent or slight, what becomes more important is the fact that the patient could die while waiting for a heart.

By publishing their recent study, Khush and her colleagues hope to communicate the importance of regulating standards for suitable hearts around the country. This may help end the reality that many potentially acceptably donor hearts are going to waste. Although many are, not all of the rejected hearts are discarded. Sometimes Canada may accept a heart that doctors in the United States reject.